Basic Information
| Provider Information | |||||||||
| NPI: | 1205997210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | MAE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 FORUM BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652035654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734494936 | ||||||||
| FaxNumber: | 5734496795 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 RIPLEY ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652015738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734429944 | ||||||||
| FaxNumber: | 5734425345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2003005274 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.